Periodontal Maintenance Therapy

            After treatment for periodontal disease with scaling and root planing or surgery, the work is not over. Bacteria that cause the disease do not go away completely.

If your gums respond well to the initial treatment, we must work to preserve the health of the gums, to prevent gum disease from returning and continuing its destructive course. We do this with periodontal maintenance therapy (perio maintenance). Perio maintenance is a process in which we monitor gum health, remove plaque and calculus, and plan our strategy to promote a favorable outcome in the fight against tooth loss.

            Much like scaling and root planing, perio maintenance involves cleaning below the gum line with traditional cleaning instruments or ultrasonic scalers. The entire tooth is still cleaned including the roots down to the base of the pockets, however, there is usually significantly less calculus and debris to remove.  Perio maintenance costs less, takes less time, and is usually more comfortable than the first treatments of scaling and root planing, in fact, the majority of people report little to no discomfort with the procedure.

            Gums are checked by visual examination and gentle probing of pocket depths. Bone levels are checked using x-rays, which are compared to previous images. When we evaluate the gums and bone around teeth we will note areas that would benefit from more treatment such as placement of antibiotic or areas where home care needs to be improved. If we notice spots that need a little extra help we will inform you, and together we will plan for the successful treatment of your condition.

            If we find in our assessment that the gums are not responding well, we will need to shift our strategy from maintenance back to treatment of active disease. This may mean more scaling and root planing, periodontal surgery, or referral to a periodontist (a specialist that focuses primarily on the health of the gum and bone around teeth).

            For periodontal maintenance to be successful, it is critical to schedule the appropriate interval between appointments. The frequency of the perio maintenance procedures is case dependent. We want to minimize how often you need to return, but we need to make sure we do not allow enough time for disease to flare up again. Most patients are seen every 3 to 4 months. At each visit your dentist will determine when your next perio maintenance should be scheduled. As your condition improves more time will be allowed between appointments.

            Many of my patients have heard me use an analogy comparing the treatment of periodontal disease to fighting a forest fire. After we put out the blaze with scaling and root planing, we need to follow up with periodontal maintenance procedures, like the fire watch looking out for a re-kindle. Perio maintenance lets us extinguish the isolated smoldering embers of gum disease before it spreads throughout the mouth again.

            Perio maintenance alone will not keep gum disease at bay. Periodontal disease cannot be controlled without proper home care. Quitting habits such as smoking and use of smokeless tobacco will greatly improve your gums ability to heal. We may recommend the use of additional home cleaning aids such as small brushes to clean between tooth roots or a special type of floss.

            Periodontal maintenance is a set of procedures used to keep chronic periodontitis in check after the initial treatment to stop progression of the disease. Keeping regular perio maintenance visits and stepping up the home care can stabilize the condition of the gums and greatly improve the odds of keeping your remaining teeth.